Common COPD Co-Morbidities
Helping patients with chronic obstructive pulmonary disease (COPD) is a difficult task in and of itself. Making this task more difficult is the fact that the disease is frequently associated with various co-morbidities.
A morbidity is a medical condition that makes a person not perfectly healthy. In this way, pretty much any disease process is referred to as a morbidity. A co-morbidity is the term used to describe a medical condition that typically exists side-by-side with another medical condition.
Some examples of COPD co-morbidities are:
Cancer. The most common cause of COPD is cigarette smoke. It’s also the number one cause of various cancers, such as lung cancer. So it’s not uncommon for physicians to have to treat the two conditions together.
Pulmonary infections, like pneumonia. The disease process often creates excessive goblet cells that increase mucus secretion. Chronic bronchitis also depresses the ability to bring up and spit up these secretions. Making this worse is the inability to take in a deep enough breath to cough. Secretions that stack up in diseased lungs may become breeding grounds for infectious materials, including viruses and bacterium.
Osteoporosis. This is a disease that causes bones to become weak or brittle. It can be caused due to long-term systemic corticosteroid use, medicines commonly used to treat COPD.
Depression. Those diagnosed with this disease are often forced to make lifestyle changes as the disease progresses in order to cope. Over time this can lead wear on a person’s overall well-being leading to a gloomy outlook.
Anxiety. This may be caused by COPD flare-ups or the feeling you can’t catch your breath. It may also be caused by fear of the unknown, such as not knowing what might set off a flare-up, or fear of emergency rooms. It may also be caused by fear of what might happen if help is not sought. It may also be caused by medicines used to treat COPD.
Confusion and dementia. No one really knows for sure what would cause this, although some studies have linked them with cigarette smoke. They also might be the result of hypoxia (low oxygen levels) that may occur during flare-ups or as the disease progresses.
Metabolic Syndrome. Risk factors such as a sedentary life, obesity, smoking, and poor diet might increase the risk of developing heart disease, stroke, and diabetes.
Coronary Artery Disease. This is when a waxy substance called plaque develops in arteries, causing them to become hard and narrow. This increases the risk for heart attack and stroke. Since a poor diet and cigarette smoking are causes of both diseases, they often exist side by side.
Pulmonary Vascular Disease. As the disease progresses, less oxygen may get to certain areas inside the lungs. When this occurs, the body tries to compensate by constricting arteries to speed up the flow of blood, hoping to pick up more oxygen molecules. The end result here is that more oxygen is not picked up and, as these diseased areas take over more of the lungs, the heart eventually poops out and fails.
Congested Heart Failure (CHF). After years of working hard to pump blood through diseased lungs, the heart may simply become too pooped to keep up with the demands of the body. This causes fluid to back up into the lungs resulting in COPD flare-ups that may come upon fast and may result in severe dyspnea. A doctor will have to determine if the flare-up is caused by COPD or CHF, as both are treated differently.
Hypertension. Many things that cause COPD may also cause high blood pressure, including poor diet, obesity, stress, depression, genetics, and smoking. Progression of COPD itself may also cause it. So it’s not uncommon for COPD patients to also be on some form of blood pressure medicine. Likewise, systemic corticosteroids used to treat and prevent chronic inflammation in COPD airways may cause fluid retention that results in hypertension. This may be treated with diuretics, and prevented by low dose and short duration steroid therapy only when needed.
Diabetes. Again, many things that cause COPD may also cause diabetes, including poor diet, stress, sedentary living, and smoking. Chronic inflammation associated with COPD may also cause it. Systemic corticosteroids used to treat and prevent COPD flare-ups may compound the issue of diabetes, making these patients very difficult to treat. So doctors may be forced to prescribe low dose steroids when high doses are needed. Regular glucose checks will be required for these patients.
Atrial Fibrillation. This is an irregular heartbeat that may be caused by high blood pressure, heart attacks, medicine, and smoking. It may increase the risk of stroke, and may be treated. However, it may also become chronic.
Skeletal muscle wasting. Some COPD patients become increasingly sedentary in order to prevent dyspnea (air hunger) that may occur with exertion. When muscles aren’t used, they become weak and shrink. This may result in weak arm and leg muscles, making it difficult to walk or do simple tasks. In severe cases, it may result in weak muscles of inspiration, making it difficult to take a deep breath and cough to clear secretions, something that is essential to prevent lung infections, such as pneumonia.
Cachexia. This is wasting away that occurs due to skeletal muscle wasting, loss of appetite, and weakness. These patients often present with a weak, frail, thin, and sickly deportment.
Normocytic Anemia. This is a type of anemia (loss of blood volume) associated with chronic disease. It’s possibly caused by the inflammation associated with COPD, although the exact cause is unknown.
These COPD co-morbidities do not appear equally in all COPD patients. Some may have none and some may have them all. But, in all actuality, most probably have at least one or two. Often, as the disease progresses, co-morbidities gradually develop, further complicating care.
The good news is that many of them can be prevented, or at least more easily controlled, simply by quitting smoking immediately and working with your physician to control your disease and to live an active life with COPD.
John Bottrell is a registered Respiratory Therapist. He wrote for HealthCentral as a health professional for Asthma and Chronic Obstructive Pulmonary Disease (COPD).